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Diagnostics
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Clinical Diagnosis and Treatment of Chronic Pain, Second Edition
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Clinical Diagnosis and Treatment of Chronic Pain, Second Edition

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: 31 March 2025 | Viewed by 3513

Special Issue Editor

Dr. Ferran Cuenca-Martínez

E-Mail Website
Guest Editor
Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
Interests: pain assessment; pain memory; pain management
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues, 

Chronic pain is a current public health problem, and countries are spending large amounts of money on its management. The approach seems unclear because it meets a multidimensional problem that must be encompassed in the patient-centered model from a biopsychosocial paradigm. Currently, more than 85% of chronic pain problems are non-specific in origin. This indicates that imaging tests do not provide clear information to establish an accurate pathoanatomical diagnosis. The process of pain chronification is complex, and seems to involve different causative factors, including molecular, individual, and social aspects. We need high-quality research to address the issue of chronic pain diagnosis in order to subclassify patients and try to make better diagnoses and, consequently, better treatments—especially more specific treatments in order to improve the quality of life and activities of daily living in patients with chronic pain.

This Special Issue is aimed at researchers investigating the diagnosis of chronic pain processes including imaging and neuroimaging tests, somatosensory assessments, clinical prediction models, reviews dealing with chronic pain diagnosis, pain subclassifications, etc., as well as those dealing with chronic pain treatments after a more precise and updated diagnosis with respect to large groupings of chronic pain populations that continue to be labelled under the word “non-specific”. With this Special Issue we hope to shed light on this important subject where chronic pain itself is already understood as a clinical entity in itself.

Dr. Ferran Cuenca-Martínez
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • chronic pain
  • pain diagnostics
  • pain classification
  • pain management
  • pain approach
  • biopsychosocial

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Published Papers (4 papers)

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Research

11 pages, 1424 KiB  
Article
Can Clinical, Psychophysical or Psychological Variables Help in Discriminating Women with Migraines from a Tertiary Center? A Diagnostic Accuracy Study
by Margarita Cigarán-Mendez, Juan C. Pacho-Hernández, Francisco G. Fernández-Palacios, Ángela Tejera-Alonso, Juan A. Valera-Calero, Cristina Gómez-Calero, Carlos Ordás-Bandera and César Fernández-de-las-Peñas
Diagnostics 2024, 14(24), 2805; https://doi.org/10.3390/diagnostics14242805 - 13 Dec 2024
Viewed by 442
Abstract
Background: Migraine diagnosis is mainly clinically based on symptomatology. The objectives of this study were (1) to determine the ability of pain thresholds to differentiate between women with and without migraines and (2) to determine the ability of clinical, psychological and psychophysical variables [...] Read more.
Background: Migraine diagnosis is mainly clinically based on symptomatology. The objectives of this study were (1) to determine the ability of pain thresholds to differentiate between women with and without migraines and (2) to determine the ability of clinical, psychological and psychophysical variables to differentiate between women with episodic and chronic migraines. A diagnostic accuracy study was conducted. Methods: Pressure-pain thresholds (PPTs) at one trigeminal (temporalis muscle) and one extra-trigeminal (cervical spine) and two distant-pain free (second metacarpal and tibialis anterior muscle) areas, as well as dynamic pain thresholds (DPTs), were bilaterally assessed in 100 women with migraines, recruited from tertiary hospitals (50% episodic, 50% chronic), and 50 comparable women without headaches. Migraine pain features (headache diary), migraine-associated burden (HDI), anxiety and depressive levels (HADS) and state (STAI-S)–trait (STAI-T) anxiety were also evaluated. The area under the receiver operating characteristic (ROC) curve, with optimal cut-off points, as well as the sensitivity, specificity and positive/negative likelihood ratios (LR) for each variable, were calculated. The women with migraines showed lower PPTs and DPTs than those without migraines. Results: The women with chronic migraines showed lower PPTs in the temporalis muscle than the women with episodic migraines. No clinical, psychological or psychophysical variables exhibited acceptable ROC values (≥0.7) for differentiating between women with and without migraines or between women with episodic and chronic migraines. Conclusions: Although the women with migraines had widespread pressure-pain hyperalgesia, neither the clinical, psychological nor psychophysical (pain threshold) variable exhibited the proper diagnostic accuracy to distinguish between women with and without migraines or between women with episodic and chronic migraines. New studies should clarify the clinical relevance of the findings of the current study. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Chronic Pain, Second Edition)
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12 pages, 507 KiB  
Article
The Utility of Pre-Procedural Blood Tests in Neuraxial Blocks: A Retrospective Study in High-Risk Patients
by Sungho Moon and Daeseok Oh
Diagnostics 2024, 14(22), 2588; https://doi.org/10.3390/diagnostics14222588 - 18 Nov 2024
Viewed by 652
Abstract
Background/Objectives: The necessity and clinical utility of routine pre-procedural blood tests (PBTs) before neuraxial blockade remain controversial. This study evaluates the effectiveness of PBTs in identifying clinically significant conditions in an outpatient setting. Methods: This single-center retrospective study involved patients who [...] Read more.
Background/Objectives: The necessity and clinical utility of routine pre-procedural blood tests (PBTs) before neuraxial blockade remain controversial. This study evaluates the effectiveness of PBTs in identifying clinically significant conditions in an outpatient setting. Methods: This single-center retrospective study involved patients who received neuraxial blockades from January 2020 to August 2023. We extracted medical information and laboratory data from the electronic medical records during the pre-procedural period. Through a multivariate regression analysis, we identified patient factors associated with abnormal laboratory results. Results: Advanced age (OR, 1.021; p = 0.026) and a history of cancer (OR, 2.359; p = 0.016) were significantly associated with elevated CRP levels (>0.30 mg/dL). Severe hyperglycemia (≥200 mg/dL) was found in 24 patients (3.88%), with a history of cancer being a strong predictor (OR, 6.764; p < 0.001). No significant abnormalities were observed in PT or PTT. Reduced eGFR (<60 mL/min/1.73 m2) was detected in 8.62% of patients, despite no prior history of renal dysfunction. A multivariate analysis revealed that advanced age, hypertension, cancer, and coronary artery disease were significant predictors of abnormal PBT results, highlighting the importance of selective testing in high-risk patients. Conclusions: Routine PBTs are not universally required for all patients undergoing neuraxial blockade but can provide crucial information in high-risk populations. A selective testing approach based on individual risk factors is recommended to optimize patient safety and resource utilization. Future studies should aim to establish clear guidelines for targeted PBT use. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Chronic Pain, Second Edition)
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16 pages, 2343 KiB  
Article
Ultrasound Evaluation of Onset Core Muscle Activity in Subjects with Non-Specific Lower Back Pain and Without Lower Back Pain: An Observational Case–Control Study
by María Cervera-Cano, David Valcárcel-Linares, Samuel Fernández-Carnero, Luis López-González, Irene Lázaro-Navas and Daniel Pecos-Martin
Diagnostics 2024, 14(20), 2310; https://doi.org/10.3390/diagnostics14202310 - 17 Oct 2024
Viewed by 999
Abstract
Lower back pain (LBP) has been the leading cause of disability since 1990. Objectives: The main objective of this observational case–control study was to evaluate, using ultrasound, whether there were differences in the onset and ratio of core muscle contraction between subjects [...] Read more.
Lower back pain (LBP) has been the leading cause of disability since 1990. Objectives: The main objective of this observational case–control study was to evaluate, using ultrasound, whether there were differences in the onset and ratio of core muscle contraction between subjects with non-specific chronic lower back pain and healthy subjects. Methods: A total of 60 participants (52% women), split between those with non-specific chronic lower back pain (n = 26) and healthy (n = 34) subjects, were recruited. Initial muscle contraction of the lateral abdominal wall, pelvic floor, lumbar multifidus, and respiratory diaphragm was measured using ultrasound. The abdominal drawing-in maneuver, contralateral arm elevation, the Valsalva maneuver, and voluntary contraction of the pelvic floor in seated and standing positions were performed. The muscle thickness of the lateral abdominal wall and lumbar multifidus and excursion of the pelvic floor and diaphragm at rest and during testing were also analyzed. Results: No differences were found between the groups in the initial contraction. Statistically significant differences were found in the following variables: diaphragm excursion (p = 0.032, r = 0.277) and lumbar multifidus ratio (p = 0.010, r = 0.333) in the standing–abdominal retraction maneuver; pelvic floor excursion (p = 0.012, r = 0.325) in the standing–contralateral arm raise; and transverse abdominis ratio (p = 0.033, r = 0.275) in the sitting–contralateral arm raise. A statistically significant interaction between the groups and body mass index was observed in resting diaphragm excursion (p = 0.018, partial eta squared = 0.096) during sitting–voluntary pelvic floor contraction. Conclusions: It cannot be concluded that there is a specific pattern of core activation in any of the groups. However, statistically significant differences were found in the contraction indexes of the lumbopelvic musculature. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Chronic Pain, Second Edition)
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11 pages, 1809 KiB  
Article
Validation of Fixed Ultrasonography for Achilles Tendon Assessment: A Reliability Study
by Raquel Alabau-Dasi, Gabriel Dominguez-Maldonado, Ana Belen Ortega-Avila, Luis M. Gordillo-Fernandez, Mercedes Ortiz-Romero, Juan Manuel Melchor-Rodriguez and Gabriel Gijon-Nogueron
Diagnostics 2024, 14(19), 2221; https://doi.org/10.3390/diagnostics14192221 - 5 Oct 2024
Viewed by 876
Abstract
Background: It is important to highlight the advantages of ultrasound in assessing muscular and tendinous behavior due to its non-invasive nature and capacity for dynamic studies. However, evaluating tendons via ultrasound can be challenging given the complexity of anisotropic phenomena related to collagen [...] Read more.
Background: It is important to highlight the advantages of ultrasound in assessing muscular and tendinous behavior due to its non-invasive nature and capacity for dynamic studies. However, evaluating tendons via ultrasound can be challenging given the complexity of anisotropic phenomena related to collagen fiber arrangement. This study aims to validate the reliability of fixed ultrasound compared to manual acquisition in measuring Achilles tendon thickness. Method: Twenty participants, six men and fourteen women, were recruited. Ultrasound was used to measure the Achilles tendon’s thickness at two specific points (4 and 6 cm from the calcaneal insertion of the Achilles tendon). The measurements were conducted by two examiners, one with previous experience and another without. Results: The measurements at 6 cm from the calcaneal insertion showed α = 0.996, α = 0.998 for measurements at 4 cm using manual acquisition, and α = 0.997 for measurements with fixed ultrasound at rest. For the weight-bearing and ankle dorsiflexion measurements, the reliability was excellent (α = 0.999 and α = 1.000). Conclusions: The findings demonstrated excellent reliability in the ultrasound measurements of the Achilles tendon’s thickness, even when performed by different evaluators and under load-bearing conditions. This study suggests the clinical utility of assessing anatomical structures under load, enhancing ultrasound’s applicability beyond the examination table. It is concluded that fixed ultrasound acquisition exhibits excellent reliability in measuring the Achilles tendon’s thickness, offering potential benefits for precise diagnosis of pathologies, planning surgical interventions, and reducing possible errors related to operator variability. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Chronic Pain, Second Edition)
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